Radiation protection challenges and trends in PET/CT
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1 Radiation protection of patients and staff in diagnostic nuclear medicine and hybrid imaging Radiation protection challenges and trends in PET/CT Makoto Hosono, MD PhD Kinki University School of Medicine, Osaka-Sayama, Japan
2 PET Institute of Advanced Clinical Medicine Kinki University Positron Emission Tomography (Ataraxia)
3 Lung cancer CT PET PET/CT
4 Colon cancer SUVmax=6.7 SUVmax=6.8
5 Radiation Therapy Planning Gross Tumor Volume Contrast enhanced CT FDG-PET/CT
6 PET Department PET/CT E-soft Workstation Export to RT Planning system
7 Radiation Therapy Department RT Planning system: Eclipse Varian 21EX
8 PET/CT (PET) procedures in Japan
9 Background PET/CT is now an indispensable imaging modality in various clinical circumstances. Considering the increasing number of PET/CT procedures and required quality, measures of Radiation Protection should evolve accordingly.
10 Radiation protection challenges and trends in PET/CT Radiation protection of patients Radiation protection of staff
11 Radiation protection challenges and trends in PET/CT Radiation protection of patients Radiation protection of staff
12 Safety Reports Series No.58 IAEA, 2008 Requirements in PET/CT Patient dose management Optimization of PET scan and CT scan
13 Patient doses of PET/CT Estimation in Safety Reports Series No.58 IAEA, 2008
14 CTDIvol and DLP CTDIvol and DLP are displayed on CT (PET/CT) scanners.
15 Normalized value of Effective Dose per DLP Conversion coefficient NRPB-W67
16 CT dose in PET/CT A typical low-dose CT dose in a PET/CT study (with automatic exposure control) If 50 mas, 130 kv, DLP=500, Effective dose of 7.5 msv (with a conversion coefficient of 0.015, NRPB- W67)
17 FDG-PET dose in PET/CT FDG msv/mbq (ICRP Publication 80) If 250 MBq injected, Effective dose of 4.8 msv
18 A typical dose in PET/CT FDG-PET 4.8 msv < CT 7.5 msv CT dose reduction is a challenge in radiation protection for patients for PET/CT.
19 CT dose reduction by iterative reconstruction 29-64% of CT dose reduction Hara et al. AJR 2009;193:
20 CT reconstruction FBP at 25 mgy Iterative at 12.5 mgy Hara et al. AJR 2009;193:
21 High Definition PET;DOI Depth of interaction, DOI, 3D scintillator gammaray detector Spatial resolution of ~1 mm, Higher Sensitivity Murayama, H et al: Design of a depth of interaction detector with a PS-PMT for PET. IEEE Trans. Nucl. Sci., 47, , 2000.
22 PET/MR PET (semiconductor detector) MR(high-end 3T)
23 Radiation protection challenges and trends in PET/CT Radiation protection of patients Radiation protection of staff
24 Radiation to Staff in PET exams Larger doses to Staff when handling 18 F Radionuclide Dose rate constant (μsv/m 2 /100MBq/h) 18 F m Tc Tl 1.74
25 PET facility
26 Equipment and layout Shield 80x60cm t=30mm lead Shield 184x90cm t=3mm lead Shield for waste fluid bottle t=55mm lead
27 Table Injector
28 Uptake Rooms single room booth with lead shield reduce patients feelings of isolation reduce radiation doses of personnel
29 PET/CT Exposure dose to Staff Nurse: initially 2 µsv / patient now µsv / patient
30 Radiation Exposure to Staff Graded approach according to Activity of Daily Living (ADL) Patients were categorized into 5 groups on the basis of ADL (ADL I; normal, ADL V; needs extensive care). Contact time and exposed radiation dose of nurses were recorded and assessed.
31 Results Radiation doses of Nurses ADL Ⅰ Ⅱ Ⅲ Ⅳ Ⅴ Patients (%) 21(42.0%) 16(32.0%) 11(22.0%) 0(0.0%) 2(4.0%) ADL of Patients and Types of Care Ⅰ: No special care Ⅱ: Accompanying from room to room Ⅲ: Assistance when getting on scanner table or wheel chair IV: Partial assistance during uptake and scan Ⅴ:General assistance using Stretcher Mean age (years) Mean care time (minutes) Dose(μSv )
32 Discussion Most of patients have good ADL, only 4% with poor ADL. Minimize contact with patients of good ADL, let them do it by themselves. Contact with patients of poor ADL may not substantially increase total radiation dose of staff. Still, assistance of family members may be requested.
33 Conclusions Increasing quality and quantity in PET/CT practices require Radiation Protection for both patients and staff. For this, good cooperation among staff members is essential.
34 Thank you very much
35
Autoradiograph of Ra-223
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